Reproductive health and pregnancy management in liver transplantation recipients

초록

Pregnancy in liver transplantation (LT) recipients has become an increasingly important topic in hepatology and obstetrics. Chronic liver disease, once predominantly affecting older individuals, is now more common among women of reproductive age due to rising prevalence of metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease. While cirrhosis can impact fertility through various mechanisms, many women retain or regain fertility with improved liver function. LT typically restores gonadal function, with 70%–95% of recipients experiencing menstrual normalization within a year. Pregnancy in LT recipients is considered high-risk, requiring careful management and multidisciplinary care. Most experts recommend waiting at least 1–2 years post-transplantation before conception to allow for graft stabilization and reduced immunosuppression. Pre-pregnancy management includes adjusting immunosuppressive agents, folic acid supplementation, cervical cancer screening, and appropriate vaccinations. Maternal complications in LT recipients include higher rates of pregnancy-induced hypertension, pre-eclampsia, and gestational diabetes compared to the general population. Fetal outcomes show higher rates of preterm birth and intrauterine growth restriction, though live birth rates have improved over time. The incidence of congenital abnormalities appears comparable to the general population. Postpartum management requires close monitoring of immunosuppressant levels and regular follow-ups. Breastfeeding is not absolutely contraindicated, but requires careful consideration of potential risks and benefits. This review summarizes current knowledge on fertility and pregnancy outcomes in these populations.

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